1. Field of the Invention
This invention relates to surgical instruments used to grasp, move and hold tissue during surgery.
2. State of the Art
As shown in FIG. 1, the human digestive system includes a biliary tract (gall bladder and bile ducts) that carries and stores bile that contains substances that allow fats to be emulsified. Bile also stimulates the secretion of an enzyme concerned with the breakdown of fats. Bile is secreted by the liver and stored in the gallbladder until needed. The gallbladder is a small pear-shaped organ. When fat is eaten, the gallbladder is stimulated to contract and bile stored in the gallbladder flows down the cystic duct, into the common bile duct and to the small intestine. As well as acting as a storage vessel, the gallbladder concentrates the bile within it by removing water through its wall.
The most common disorder of the biliary tract is gallstones. Why and how gallstones form is not fully understood, but it is thought that in some cases an abnormality in function causes the gallbladder to remove an excessive amount of water from the bile so that some of its constituents can no longer remain in solution. Gallstones occur very frequently in developed countries and may be associated with eating a diet that is high in fat and refined carbohydrates and low in fiber. Gallstones can give rise to various problems, including cholecystitis (inflammation of the gallbladder), choledocholithiasis (gallstones in the common bile duct), cholangitis (infection of the bile ducts), pancreatitis, and gallstone ileus (obstruction of the intestines by a gallstone). Other disorders of the biliary tract include biliary sludge and dysmotility (poor physiological function). Treatment of such disorders can involve laparoscopic gallbladder removal (laparoscopic cholecystectomy).
Laparoscopic cholecystectomy requires one or more small incisions in the abdomen to allow the insertion of laparoscopic surgical instruments and a small video camera into the abdominal cavity. After the initial incision(s), the abdominal cavity is inflated with gas (typically carbon dioxide) and the camera is positioned in the abdominal cavity. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. The surgeon watches the video monitor and performs the operation by manipulating laparoscopic surgical instruments that extend into the abdominal cavity.
Typically, laparoscopic cholecystectomy is carried out by lifting the left lobe of the liver by manipulation of hook retractor to identify and clear Calot's Triangle (the area bound by the liver, cystic duct, and common hepatic duct). With the liver being held by the hook retractor, the gallbladder is grasped by non-crushing grasping mechanical forceps (e.g., Rotweiler forceps) and lifted up and away from the liver bed. With the liver held by the hook retractor and the gallbladder held by the forceps, the cystic duct is dissected free from the overlying tissue and the cystic duct and then clipped and cut. The cystic artery in then dissected, clipped and cut. The gallbladder is separated from the liver bed typically by a spatula-shaped instrument. The spatula design is ideal for conforming to the gallbladder bed and bluntly dissecting the gallbladder from the liver. Care is taken to not enter the gallbladder to prevent spillage of infected bile or gallstones. Any bleeding points seen on the liver bed are cauterized. With a small length of gallbladder remaining on the liver bed, the gallbladder is retracted towards the abdominal wall by the mechanical forceps to allow for visualization of the liver bed. The gallbladder is then completely removed from the liver bed and placed in a tissue retrieval bag (e.g., Endo-bag). The bag is closed and then removed from the abdominal cavity. Fluid irrigation and suction in the vicinity of the liver is performed typically until the fluid being returned is clear. All instruments are removed from the abdominal cavity, pressure is applied to the outside of the abdominal wall to express as much of the pneumoperitoneum (insufflation gas) as possible, and the incision site(s) are sutured closed.
As part of the laparoscopic cholecystectomy, the handle of the hook retractor that is used to lift and hold the liver remains in the working field of the surgeon(s) external to the abdomen and can interfere with hand movement of the surgeon(s) in this space. Moreover, to hold the liver in place, the hook retractor requires manual fixation by a surgeon (or mechanical fixation by a support structure disposed outside the abdominal cavity) that holds the retractor in place, thus increasing the complexity of the procedure.
Similar problems arise when using retractors and other instruments to manipulate other organs and tissue during laparoscopic and non-laparoscopic surgeries involving the abdominal cavity, such as surgeries involving the small intestine, large intestine, stomach, spleen, liver, pancreas, kidneys, and adrenal glands.
Moreover, similar problems arise when using retractors and other instruments to manipulate other organs and tissue during laparoscopic and non-laparoscopic surgeries involving the thoracic cavity or pelvic cavity, such as surgeries involving the heart, thoracic aorta, the pulmonary artery and all its branches, the superior and inferior vena cava, the pulmonary veins, the trachea, the bronchi and lungs, the esophagus, the endocrine glands, the thoracic duct, the reproductive organs, the urinary bladder, and the rectum.
Laparoscopic surgery as used herein means any surgery that involves one or more small incisions into a body cavity that allow for the insertion of laparoscopic surgical instruments and a small video camera into the body cavity. After the initial incision(s), the body cavity can be inflated with gas (typically carbon dioxide) and the camera is positioned in the body cavity. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. The surgeon watches the video monitor and performs the operation by manipulating laparoscopic surgical instruments that extend into the body cavity. Laparoscopic surgery includes natural orifice translumenal endoscopic surgery (commonly referred to as “NOTES”) where operations are performed with an endoscope passed through a natural orifice (mouth, urethra, anus, etc.) then through an internal incision into the stomach, vagina, bladder or colon into the desired body cavity (e.g., abdomen). NOTES is advantageous because it avoids external incisions and scarring associated therewith. Laparoscopic surgery also includes single port access (SPA) surgery, which is also known as single incision laparoscopic surgery (SILS™) or one port umbilical surgery (OPUS) or natural orifice transumbilical surgery (NOTUS). SPA is a minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient's umbilicus.
Thus, there is a need for improved devices that can effectively grasp, retract and hold body organs and tissue during surgical procedures with minimal risk in rupturing and/or otherwise damaging such tissue.